The influence of race/ethnicity and place of service on breast reconstruction for Medicare beneficiaries with mastectomy

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  • Onega, Tracy
    • Other Affiliation: Department of Community & Family Medicine; Norris Cotton Cancer Center; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  • Weiss, Julie
    • Other Affiliation: Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, HB 7927 Rubin 8, Lebanon, NH 03756, USA
  • Kerlikowske, Karla
    • Other Affiliation: Departments of Medicine and Epidemiology and Biostatistics; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
  • Wernli, Karen
    • Other Affiliation: Group Health Research Institute, Seattle, WA, USA
  • Buist, Diana SM
    • Other Affiliation: Group Health Research Institute, Seattle, WA, USA
  • Henderson, Louise
    • Affiliation: School of Medicine, Department of Radiology
  • Goodrich, Martha
    • Other Affiliation: Department of Community & Family Medicine; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  • Alford-Teaster, Jennifer
    • Other Affiliation: Department of Community & Family Medicine; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  • Virnig, Beth
    • Other Affiliation: School of Public Health, University of Minnesota, Minneapolis, MN, USA
  • Tosteson, Anna NA
    • Other Affiliation: Norris Cotton Cancer Center; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  • DeMartini, Wendy
    • Other Affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-3252, USA
  • Hubbard, Rebecca
    • Other Affiliation: Group Health Research Institute, Seattle, WA, USA
Abstract
  • Racial disparities in breast reconstruction for breast cancer are documented. Place of service has contributed to disparities in cancer care; but the interaction of race/ethnicity and place of service has not been explicitly examined. We examined whether place of service modified the effect of race/ethnicity on receipt of reconstruction. We included women with a mastectomy for incident breast cancer in SEER-Medicare from 2005–2009. Using Medicare claims, we determined breast reconstruction within 6 months. Facility characteristics included: rural/urban location, teaching status, NCI Cancer Center designation, cooperative oncology group membership, Disproportionate Share Hospital (DSH) status, and breast surgery volume. Using multivariable logistic regression, we analyzed reconstruction in relation to minority status and facility characteristics. Of the 17,958 women, 14.2% were racial/ethnic women of color and a total of 9.3% had reconstruction. Caucasians disproportionately received care at non-teaching hospitals (53% v. 42%) and did not at Disproportionate Share Hospitals (77% v. 86%). Women of color had 55% lower odds of reconstruction than Caucasians (OR = 0.45; 95% CI 0.37-0.55). Those in lower median income areas had lower odds of receiving reconstruction, regardless of race/ ethnicity. Odds of reconstruction reduced at rural, non-teaching and cooperative oncology group hospitals, and lower surgery volume facilities. Facility effects on odds of reconstruction were similar in analyses stratified by race/ethnicity status. Race/ethnicity and facility characteristics have independent effects on utilization of breast reconstruction, with no significant interaction. This suggests that, regardless of a woman’s race/ethnicity, the place of service influences the likelihood of reconstruction.
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DOI
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Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Tracy Onega et al.; licensee BioMed Central Ltd.
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Journal title
  • SpringerPlus
Journal volume
  • 3
Journal issue
  • 1
Page start
  • 416
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 2193-1801
Bibliographic citation
  • SpringerPlus. 2014 Aug 08;3(1):416
Publisher
  • Springer
Access right
  • Open Access
Date uploaded
  • August 26, 2015

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